There has been much discussion about healthcare expenses in recent months. The Centers for Medicare & Medicaid Services (CMS) is focusing on value-based purchasing (VBP), and payors are focused on reducing costs through...

ICD-10 coding should be high-priority on everyone’s list this year as we await the rollout of the Patient-Driven Payment Model. I do not think it can be stressed enough that diagnoses are driving reimbursement. 

The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment fades away, alternative payment models like bundled payments are helping to define the future of revenue cycle management.

On a recent onsite, one of the clinical documentation integrity specialists (CDISs) asked me my opinion on how assiduous a clinical documentation integrity (CDI) professional should be to get a query answered. My response may surprise some of you.

Technology is enabling patients and providers to connect in an unprecedented manner. The Internet, smartphones, wearables, and other technologies are allowing for instantaneous communication...

The ambiguities of Medicare regulations often create conundrums for case managers and physician advisors as we try to advocate for our patients while remaining compliant.